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Prescription Drug Program
All medical plans incorporate a prescription drug program, which is subject to coordination of benefits with other medical or prescription plans. If a spouse, domestic partner, or dependent is covered by another medical or prescription plan, and that plan is considered primary, his/her prescriptions must be processed through their medical or prescription plan. If that plan's copay or coinsurance cost is more than the Humana plan, the receipt or Explanation of Benefits (EOB) may be submitted to Humana for the difference between the primary plan's copay or coinsurance and the Humana copay.
For information on copayments, refer to the Medical Plan Comparison Chart.
Plan Utilization Management Features
Jump To
- Prescription Drug Program
- 2013 RX3 Drug List (AAUP, ONA, AFSCME, FOP-D, IUOE)
- Prescription Drug Progam
- 2013 RX4 Drug List (Unrepresented, SEIU, FOP-SO, FOP-LE)
- RightSource Preferred Essentials Guide
- RightSource Trifold
Prior Authorization
Before the Plan will pay for certain medicines, the doctor must get advance approval from Humana. This is called “prior authorization.” This ensures these drugs are being used correctly for a health condition. Without prior authorization, the pharmacy can’t fill the prescription.
Step Therapy
This means at least one other medicine must be tried before Humana will cover a step-therapy drug. These other medicines are effective, lower-cost drugs that treat the same health condition.
If other medicines have been tried or the doctor thinks they aren’t right for you, the doctor can request approval from Humana to cover the prescription.
Quantity Limits
Quantity limits are the maximum amount of a medicine Humana will cover for one copayment or over a certain number of days. If a prescription is for more than that amount, the employee can either:
- Pay according to the plan details to get the quantity allowed, then pay the pharmacy’s retail price to get the remaining quantity of the prescription
or
- If the doctor feels it’s necessary, he or she can request a medical exception from Humana to cover the full quantity of the prescription.
Represented Employees (including AAUP, ONA, FOP-D, IUOE & AFSCME) - Effective January 2013
Information about the Prescription Drug Program
For represented employees, the Humana Prescription Drug Program is called Rx3. Prescription medications fall into one of three (3) levels. The copayment corresponds to the level on which the medicine falls. Refer to the Medical Plan Comparison Charts for copayment information.
- Level One: Generic medicines
- Level Two: Brand name medicines
- Level Three: Non formulary brand name medicines
Refer to the Rx3 listing to determine which medicines fall into each level and to identify which medications are considered maintenance medications. This listing will also identify which medications are subject to the utilization management requirements (e.g., step therapy, etc.) described above.
90 Day Supply Available at Retail:
If the prescription is for a maintenance drug, a 90-day supply can be purchased through a participating retail pharmacy or through RightSourceRx, Humana’s prescription home-delivery service. Be sure the physician writes the prescription for a 90-day supply. If using the mail order program, mail the prescription along with the paperwork to the appropriate address on the form. The prescription will be mailed to the address requested. For additional information refer to the Humana RightSourceRx website.
For unrepresented employes, the Humana prescription drug plan is called Rx4. Prescription medications fall into one of four (4) levels. The copayment corresponds to the level on which the medicine falls. Refer to the Medical Plan Comparison Chart for copayment information.
- Level One: Lower cost generic and brand name medicines.
- Level Two: Higher cost generic and brand name medicines.
- Level Three: Higher cost medicines, most brand name medicines. These medicines may have generic or brand name alternatives on Levels One or Two that may save you money. This level also includes some self-administered injectable medicines.
- Level Four: Expensive medicines. This level includes self-administered injectable medicines and high-technology medicines that are often newly approved by the U.S. Food and Drug Administration. Level Four medications require a 25% co-insurance payment at the time of purchase.
Refer to the Rx4 listing to determine which medicines fall into each level and to identify which medications are considered maintenance medications. This listing will also identify which medications are subject to the utilization management requirements (e.g., step therapy, etc.) described above.
Humana RightSourceRx - Mail Order Drug Program
Effective January 1, 2013, maintenance medicine prescriptions must be sent to RightSourceRx, Humana’s prescription home-delivery service.
A 30-day supply of a maintenance medicine may be filled two (2) times at a regular local pharmacy for the regular copayment. After that, if a maintenance medicine is filled at a local pharmacy, the cost will be twice the regular copayment.
Prescriptions for 90-day supplies at retail pharmacies will no longer be available. Read the Humana RightSourceRx brochure for more information.
Additional information is available on the RightSourceRx website.